Setting

Participants

219 spouses or significant others who were ≥18 years of age, able to read and write English, and living with a partner who
had had an acute myocardial infarction, coronary artery bypass surgery, or percutaneous transluminal coronary angioplasty
in the previous 12 months. Exclusion criteria were serious medical conditions in either the patient (other than cardiac disease)
or spouse, mental incompetence, or history of mental illness. 89% of spouses (mean age 59 y, 83% women, 91% white) completed
the follow up.

Intervention

Spouses were allocated to CPR plus social support (n=68), CPR plus risk factor education (n=67), or no treatment (n=84). One
person CPR was taught by cardiovascular clinical nurse specialists in small classes of 2–6 spouses. Training was accompanied
by a videotaped presentation. Spouses in the CPR plus social support group also participated in a 30 minute discussion led
by the instructor about the emotional issues raised by learning CPR, whereas those in the CPR plus risk factor education group
participated in a discussion about how to modify cardiac risk factors. Spouses in the no treatment control group did not receive
CPR training nor attend any discussion groups.

Main results

At 1 month after training, spouses' perceived control increased in both the CPR plus social support group and the CPR plus
risk factor education group, but remained unchanged in the no treatment control group (p=0.006). The 2 CPR groups did not
differ.

Conclusions

Training in cardiopulmonary resuscitation with a social support intervention or with risk factor education improved perceived
control in spouses of patients who were recovering from an acute cardiac event when compared with no treatment. No difference
was found between CPR plus social support and CPR plus risk factor education.

Commentary

More than half of the spouses of cardiac patients experience emotional distress,1 and they have higher levels of distress than the patients themselves.2 Despite evidence suggesting that spouses can help with their partner's recovery,3 there are few tested interventions to reduce spousal stress and improve their ability to assist in the recovery process.

Moser and Dracup hypothesised that CPR training for spouses would increase perceived control, decrease emotional distress,
and therefore, improve the ability to assist in their partner's recovery. Although the authors found that higher levels of
control were associated with low levels of distress at baseline, they did not assess whether the increase in perceived control
resulting from the CPR training had an effect on distress.

The use of a randomised controlled design is a major strength of this study. As most of the spouses were white, had incomes
higher than the average, and had completed a mean of 14 years of education, the results may not be generalisable to spouses
of different races or of lower socioeconomic status. Lower socioeconomic status is associated both with distress and negative
health behaviours.4 Unlike other studies of spousal distress in heart disease, Moser and Dracup included both husbands and wives of patients.
Although sex did not affect the outcome, it is unclear whether the study had adequate power to detect such an effect (only
17% of the spouses were men). The effects of CPR training on perceived control may differ between men and women.

Unanswered questions arising from this study include: (1) is an increase in perceived control associated with a decrease in
emotional distress? (2) Does the time between the cardiac event and training influence perceived control and emotional distress?
(3) Is there an interaction between the baseline level of perceived control and the effects of the intervention? And (4) does
an increase in perceived control improve a spouse's ability to assist in their partner's recovery? Future research should
also address the cost effectiveness of intervening with spouses.